Video based monitoring systems for hand hygiene compliance auditing: What do patients think?

BACKGROUND: Compliance with hand hygiene by healthcare workers is a vital aspect of the quality and safety in healthcare. The current method of monitoring compliance, known as direct observation, has been questioned as have the various electronic measures proposed as alternatives. In our earlier work we established the capacity of video-based monitoring systems (VMS) to collect data with increased efficacy, efficiency and accuracy. However, the spectre of the approach being seen as an unacceptable invasion of patient privacy, was raised as a barrier to implementation by healthcare workers. METHODS: In depth, semi structured interviews were conducted with 8 patients in order to explore their beliefs and options regarding the proposed approach. Interviews were transcribed and then thematic and content analysis was conducted in order to uncover themes from the data. RESULTS: Despite healthcare worker predictions, patients were generally accepting of the use of video-based monitoring systems for the auditing of hand hygiene compliance. However, this acceptance was conditional. Four interconnected themes emerged from the interview data; quality and safety of care versus privacy, consumer Involvement-knowledge, understanding and consent, technical features of the system, and rules of operation. CONCLUSION: The use of within zone VMS approaches to hand hygiene auditing has the potential to improve the efficacy, efficiency and accuracy of hand hygiene auditing and hence the safety and quality of healthcare. By combining a suite of technical and operational specifications with high level consumer engagement and information the acceptability of the approach for patients may be significantly enhanced.

Health care workers' experiences of video-based monitoring of hand hygiene behaviors: a qualitative study.

BACKGROUND: Hand hygiene is key to preventing health care-associated infections. Human observation is the gold standard for measuring compliance, but its utility is increasingly being questioned with calls for the use of video monitoring approaches. The utility of video-based systems to measure compliance according to the WHO 5 moments is largely unexamined, as is its acceptability amongst health care workers (HCW) and patients. This study examined HCW acceptability of video monitoring for hand hygiene auditing. METHODS: Following trial of a video monitoring system (reported elsewhere), 5 participating HCW attended 2 in-depth group interviews where they reviewed the footage and explored responses to the approach. Transcripts were analyzed using thematic analysis. RESULTS: Four themes were identified: 1) Fears; 2) Concerns for patients; 3) Changes to feedback; and 4) Behavioral responses to the cameras. HCWs expressed fears of punitive consequences, data security, and confidentiality. For patients, HCWs raised issues regarding invasion of privacy, ethics, and consent. HCWs suggested that video systems may result in less immediate feedback but also identified potential to use the footage for feedback. They also suggested that the Hawthorne Effect was less potent with video systems than human observation. CONCLUSIONS: The acceptability of video monitoring systems for hand hygiene compliance is complex and has the potential to complicate practical implementation. Additionally, exploration of the acceptability to patients is warranted. CHECKLIST: COREQ.

Using video-based surveillance for monitoring hand hygiene compliance according to the World Health Organization (WHO) Five Moments framework: A pragmatic trial.

OBJECTIVE: To examine the utility of video-based monitoring systems (VMSs) for auditing hand hygiene compliance according to the World Health Organization (WHO) Five Moments. DESIGN: Pragmatic quasi-experimental observation trial. SETTING: The New South Wales Biocontainment Centre, Westmead, New South Wales, Australia. PARTICIPANTS: Volunteer healthcare workers (HCWs). METHOD: Six high-fidelity simulations were recorded and subsequently assessed for their ability to audit hand hygiene compliance according to the WHO Five Moments for hand hygiene criteria using tools provided by the National Hand Hygiene Initiative (NHHI). RESULTS: In total, 206 minutes of recorded footage were reviewed in 120 minutes, yielding 111 moments. Overall HCW hand hygiene compliance was 88% according to the WHO Five Moments framework. The cost per moment was $0.91 AUD ($0.66 USD) and the time required per moment was 64 seconds. CONCLUSIONS: Auditing of hand hygiene compliance according to all 5 of the WHO Five Moments from recorded footage is not only possible but provides cost and time savings. In addition, the process may produce output that is less subject to the biases inherent in direct human observational auditing.

Randomized controlled trial of a prenatal focused coparenting consultation for unmarried black fathers and mothers: One-year infant and family outcomes.

In the infant mental health field, scant conceptual attention has been given to coparenting and family adaptations of non-white family systems, with no evidence-based, community-informed coparenting interventions responsive to unmarried Black mothers' and fathers' life circumstances. This study examined 1-year post-partum child and family outcomes of a novel, modest dosage (six sessions) prenatal focused coparenting consultation (FCC) using randomized controlled trial methodology. One-hundred-thirty-eight expectant families (one or both parents identified as Black/African American) were randomized to an intervention (N = 70) or treatment-as-usual (TAU; control) condition (N = 68). TAU families received navigational support in accessing existing community services for pregnant families. Intervention families received TAU plus 6 dyadic FCC sessions led by a Black male-female Community Mentor team. When infants were three and 12 months old, parents reported on coparenting, father engagement, interparental aggression, depressive symptoms, and infant social and emotional adjustment. Intent-to-treat analyses focusing on 12-month post-partum data indicated significant intervention effects on coparenting, interparental psychological aggression, and infants' emotional adjustment. Improvement was also seen in depression and father engagement, with gains for both groups. Results suggest FCC delivered by same-race Community Mentors to unmarried Black coparents transitioning to parenthood supports infant and family adaptation during the first year of life.

En el campo de salud mental infantil, se le ha puesto escasa atención conceptual a la compartida crianza y a las adaptaciones familiares en sistemas de familias no blancas, sin intervenciones sobre la compartida crianza basadas en la evidencia o con información comunitaria que sean sensibles a las circunstancias de mamás y papás de raza negra no casados. Este estudio examinó los resultados en el niño y la familia al año después del parto de la novedosa, prenatal Consulta de Enfoque en la Compartida Crianza (FCC) con número modesto de 6 sesiones, usando metodología de ensayo controlado al azar. Se asignó al azar ciento treinta y ocho familias durante el embarazo (uno o ambos progenitores identificados como negro o afroamericano) a una condición de intervención (N = 70) o de Tratamiento Usual (TAU; control) (N = 68). Las familias del grupo TAU recibieron apoyo direccional para lograr acceso a los servicios comunitarios existentes para familias durante el embarazo. Las familias del grupo de Intervención recibieron TAU más 6 sesiones diádicas de FCC dirigidas por un equipo comunitario de mentores compuesto por un hombre y una mujer negros. Cuando los infantes tenían tres y 12 meses de edad, los progenitores reportaron acerca de la compartida crianza, la participación del papá, la agresión entre progenitores, síntomas depresivos, y el ajuste social y emocional del infante. Los análisis con Intención de Tratar enfocados en los datos a 12 meses después del parto indicaron significativos efectos de la intervención en la compartida crianza, la agresión sicológica entre progenitores y el ajuste emocional de los infantes. También se notó mejoría en la depresión y en la participación del papá, con beneficios para ambos grupos. Los resultados indican que la FCC que dirigen mentores comunitarios de la misma raza a parejas negras no casadas en transición a ser padres apoya la adaptación del infante y la familia durante el primer año de vida.

Dans le domaine de la santé mentale du nourrisson peu d'attention conceptuelle a été donnée au co-parentage et aux adaptations de la famille dans des systèmes familiaux non-blancs, avec aucune intervention basée sur l'évidence et informée par la communauté répondant aux circonstances de vie des mères et des pères noirs. Cette étude a examiné les résultats pour l'enfant à un mois post-partum et la famille d'un nouveau dosage modéré (6 session) de la Consultation Ciblée de Co-parentage (en anglais Focused Coparenting Consultation, soit FCC) prénatale en utilisant une méthodologie d'essai contrôlé randomisé. Cent trente-huit familles attendant un enfant (un ou les deux parents identifié(s) comme Américains noirs/africains) ont été randomisés pour une intervention (N = 70) ou une condition Traitement-Comme d'Habitude (TCH; contrôle) (N = 68). Les familles TCH ont reçu du soutien à la navigation pour accéder aux services communautaires pour les familles enceintes. Les familles de l'intervention ont reçu le TCH plus 6 session FCC dyadiques menées par une équipe de Mentor Communautaire noire et formée d'un homme et d'une femme. Quand les bébés ont eu trois et 12 mois, les parents ont fait état du co-parentage, de l'engagement du père, de l'agression inter-parentale, de symptômes dépressifs, et de l'ajustement social et émotionnel du bébé. Des analyses en intention de traiter portant sur les données post-partum à 12 mois ont indiqué des effets importants de l'intervention pour le co-parentage, l'agression psychologique inter-parentale, et l'ajustement émotionnel des bébés. Des améliorations ont également été vues dans la dépression et l'engagement du père, avec des gains pour les deux troupes. Les résultats suggèrent que la FCC faite par des Mentors Communautaires de la même race à des coparents noirs non mariés transitionnant à la parentalité soutient le bébé et l'adaptation de la famille durant la première année de la vie.

Anti-Cholestatic Therapy with Obeticholic Acid Improves Short-Term Memory in Bile Duct-Ligated Mice.

Patients with cholestatic liver disease, including those with primary biliary cholangitis, can experience symptoms of impaired cognition or brain fog. This phenomenon remains unexplained and is currently untreatable. Bile duct ligation (BDL) is an established rodent model of cholestasis. In addition to liver changes, BDL animals develop cognitive symptoms early in the disease process (before development of cirrhosis and/or liver failure). The cellular mechanisms underpinning these cognitive symptoms are poorly understood. Herein, the study explored the neurocognitive symptom manifestations, and tested potential therapies, in BDL mice, and used human neuronal cell cultures to explore translatability to humans. BDL animals exhibited short-term memory loss and showed reduced astrocyte coverage of the blood-brain barrier, destabilized hippocampal network activity, and neuronal senescence. Ursodeoxycholic acid (first-line therapy for most human cholestatic diseases) did not reverse symptomatic or mechanistic aspects. In contrast, obeticholic acid (OCA), a farnesoid X receptor agonist and second-line anti-cholestatic agent, normalized memory function, suppressed blood-brain barrier changes, prevented hippocampal network deficits, and reversed neuronal senescence. Co-culture of human neuronal cells with either BDL or human cholestatic patient serum induced cellular senescence and increased mitochondrial respiration, changes that were limited again by OCA. These findings provide new insights into the mechanism of cognitive symptoms in BDL animals, suggesting that OCA therapy or farnesoid X receptor agonism could be used to limit cholestasis-induced neuronal senescence.

A culturally grounded prenatal coparenting intervention: Results of a randomized controlled trial with unmarried Black parents.

This study examines the efficacy of a prenatal intervention designed to promote healthy coparenting relationships in families where low-income, unmarried mothers and fathers were expecting a first baby together. One hundred thirty-eight Black and mixed-race mother-father dyads participated. Coparent dyads were randomly assigned to either a treatment as usual (TAU) group, receiving referrals and navigation support to existing community services (control), or to TAU plus invitation to a series of six dyadic Focused Coparenting Consultation (FCC) sessions led by a male-female mentor team (intervention). Seventy-one percent of those prenatally assessed were later reassessed at 3 months postpartum. Both mothers and fathers contributed reports of coparenting, father engagement, physical and psychological intimate partner violence (IPV), and depressive symptoms. Intent-to-treat analyses indicated: (a) some evidence that mothers in the intervention group reported more positive coparenting communication at 3 months postpartum than did control group mothers; (b) mothers in the intervention group reported significantly more time spent by fathers with the child than did control group mothers; (c) parents in the intervention group had significant reductions in psychological IPV compared to parents in the control group; and (d) both mothers and fathers showed reductions in self-reported depression over time, with no differential impact of group. Findings suggest that the FCC intervention may produce modest but important benefits for unmarried, low-income Black coparents in the transition to parenthood. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Methodological and technical considerations for video-based auditing of hand hygiene compliance in clinical practice: an exploratory study.

BACKGROUND: Direct observation is the gold standard method for measuring hand hygiene compliance but its utility is increasingly being questioned. Various alternative electronic methods have been proposed, yet there is a paucity of research examining the use of these according to the World Health Organization's (WHO) '5 Moments for Hand Hygiene'. As a part of the process of developing a video-based monitoring system (VMS) capable of measuring hand hygiene compliance against the 5 moments criteria this paper reports methodological and technical issues that might arise from the use of a VMS for auditing in clinical practice. METHODS: In-depth semi-structured interviews were conducted with 27 Australian content experts in hand hygiene auditing and infection prevention to explore their responses to proposed VMS auditing approaches. Transcripts were analyzed using thematic and content analysis. RESULTS: Technical and methodological considerations for the use of VMS were interrelated and included concerns surrounding privacy, footage security, fears of surveillance and the potential for medico-legal consequences. Additionally, possible detrimental impacts on healthcare worker (HCW) -patient relationships, issues of cost versus benefits, HCW and patient safety and changes to feedback were also identified. CONCLUSIONS: The primary methodological and technical issues to overcome in order to implement VMS for hand hygiene auditing in clinical practice, centered upon issues of acceptability to patients and health professionals, privacy, consent and liability. CHECKLIST: COREQ.

RAISe-ing awareness: Person-centred care in coercive mental health care environments-A scoping review and framework development.

WHAT IS KNOWN ON THE SUBJECT?: In mental healthcare environments, there are times when people are forced into care (i.e. to take medications or be hospitalized) when they may not want it. It is difficult to understand how person-centred care (i.e. supporting patients to lead decisions about their care) can occur within coercive settings. There is a gap in the literature about this topic as few studies have explored it. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This paper examines the research publicly available to better understand if person-centred care can exist at times when people are forced into mental health care. The paper develops a conceptual framework, RAISe (Relationship, Agency, Information, Safe environment), for understanding this matter in order to help people apply this concept in practice In certain situations, with caring and respectful approaches, with and for patients, it is possible to provide person-centred care at times when mental health care is forced. RAISe identifies ways in which this can be done by clinicians while working with people. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: These person-centred approaches need to be applied across mental health systems so that people in forced mental healthcare scenarios continue to experience dignity and respect. This is particularly important for nurses who are often the ones providing direct care to patients in these environments. ABSTRACT: Introduction Person-centred care (PCC) is founded on a theoretical premise that the person who the care issue pertains to directs the decisions relating to them. This can raise ethical challenges when mental health care is forced. Aim This paper reports on how PCC is provided in coercive mental healthcare environments and its outcomes, where reported. Method A scoping review methodology was utilized to search the literature in English until December 2019 (inclusive). Results Twenty articles were included in the review. The information found was diverse and addressed different aspects of PCC in coercive mental healthcare environments. Discussion Overall, this area is understudied. Despite ethical challenges, there are opportunities to provide PCC in coercive mental healthcare environments. A novel conceptual framework, RAISe (Relationship, Agency, Information, Safe environment), is presented to assist in applying PCC in these environments. Further research investigating how to employ these practices across systems should occur. Implications for Practice This review acknowledges the challenges of providing PCC in coercive mental healthcare environments, while suggesting that this type of care can still be delivered in general as well as specific ways. This is especially relevant for nurses who provide direct care within these environments.

Hand hygiene compliance monitoring: Do video-based technologies offer opportunities for the future?

Hand hygiene is universally recognised as the primary measure to reduce healthcare-associated infections. Studies have convincingly demonstrated a link between increased hand hygiene compliance and reductions in rates of healthcare-associated infections. Direct observation is considered the gold standard method for monitoring hand hygiene compliance. Despite the acknowledged benefits of this approach, recent literature has highlighted a range of issues impacting on the reliability and validity of this data collection technique. The rise of technology in healthcare provides opportunity for alternative methods that promise advantages over direct human observation. There have been no published examples of systems that are able to capture data consistent with all the WHO '5 Moments for Hand Hygiene'. In this paper we explore current human-based auditing practises for monitoring hand hygiene compliance and raise for discussion and debate video-based technologies to monitor hand hygiene compliance. We raise questions regarding hybrid approaches that incorporate both direct human observation and indirect video-based surveillance, and the possible advantages and disadvantages therein for monitoring hand hygiene compliance. We suggest that such methods have the potential to ameliorate, or minimise, the inherent biases associated with direct observation, notably the Hawthorne Effect. Future research into the utility of a hybrid approach to auditing, including the technical specifications, efficacy, cost effectiveness and acceptability of such a model is warranted.

Postpartum depression among rural women from developed and developing countries: a systematic review.

PURPOSE: Postpartum depression (PPD) is a significant public health problem, with significant consequences for the mother, infant, and family. Available research has not adequately examined the potential impact of sociodemographic characteristics, such as place of residence, on risk for PPD. Therefore, this systematic review and meta-analysis examines the prevalence of and risk factors for PPD in rural communities within developed and developing countries, and where possible, compares rates to those among urban women. METHODS: Five databases were searched, from start dates through early May 2010, using key words relevant to PPD and rural residence. Peer-reviewed articles were eligible if a standardized assessment of depression was administered to rural mothers within the first year postpartum. Data on PPD were extracted from 19 articles, of which 17 provided data for meta-analyses. FINDINGS: The overall prevalence of PPD among rural women was 27.0% (95% CI, 18.8%-37.2%). Prevalence was somewhat higher among women in developing countries (31.3%; 95% CI, 21.3%-43.5%) than among women in developed countries (21.5%; 95% CI, 10.9%-38.0%), although there was significant heterogeneity among both groups of studies. Comparisons between rural and urban women yielded conflicting results. Although established PPD risk factors were associated with depression in rural women, additional risk factors were reported for rural women from developing countries, such as having 2 or more young children. CONCLUSIONS: Longitudinal studies with clearly defined "rural" and "comparison" groups are needed to determine whether rural residence is associated with increased risk for PPD. The results can inform prevention and treatment programs tailored to serve rural women.