Introducing automated hand hygiene surveillance to an Australian hospital: Mirroring the HOW2 Benchmark Study

BACKGROUND

Human auditing and collating hand hygiene compliance data take hundreds of hours. We report on 24/7 overt observations to establish adjusted average daily hand hygiene opportunities (HHOs) used as the denominator in an automated surveillance that reports daily compliance rates.

METHODS

Overt 24/7 automated surveillance collected HHOs in medical and surgical wards. Accredited auditors observed health care workers' interaction between patient and patient zones to collect the total number of HHOs, indications, and compliance and noncompliance. Automated surveillance captured compliance (ie, events) via low power radio connected to alcohol-based handrub (ABHR) dispensers. Events were divided by HHOs, adjusted for daily patient-to-nurse ratio, to establish daily rates.

RESULTS

Human auditors collected 21,450 HHOs during 24/7 with 1,532 average unadjusted HHOs per day. This was 4.4 times larger than the minimum ward sample required for accreditation. The average adjusted HHOs for ABHR alone on the medical ward was 63 HHOs per patient day and 40 HHOs per patient day on the surgical ward. From July 1, 2014-July 31, 2015 the automated surveillance system collected 889,968 events.

CONCLUSIONS

Automated surveillance collects 4 times the amount of data on each ward per day than a human auditor usually collects for a quarterly compliance report.

An average hand hygiene day for nurses and physicians: The burden is not equal

BACKGROUND

To understand whether the burden of hand hygiene contributes to poor compliance we measured the daily number of hand hygiene opportunities (HHOs) by shift for nurses and physicians in 2 wards in a 850-bed university teaching hospital.

METHODS

On each ward 4 trained auditors collected the number of HHOs and compliance events for 24 hours over 7 days. Twenty-one thousand four hundred fifty HHOs were collected from a medical and a surgical ward. The proportion of alcohol-based handrub used daily, the burden of hand hygiene, and compliance rates were calculated separately for nurses and physicians.

RESULTS

The average indication for alcohol-based handrub cleansing represented 68% of all HHOs. Nurses had an average burden of 55 HHOs per 24 hours or 27 HHOs per shift, 3 times higher than the burden for physicians, who had 16 HHOs per 24 hours or 8 HHOs per shift. Overt observations of the weekly compliance identified nurses had 1.5 times higher compliance than physicians: 76% and 52% (P < .01), respectively.

CONCLUSIONS

Nurses have 3 times more HHOs than physicians, yet nurses have 1.5 times higher compliance than physicians. Hand hygiene compliance in physicians cannot be explained by burden of HHOs.

An electronically instrumented internal fixator for the assessment of bone healing

Objectives

The monitoring of fracture healing is a complex process. Typically, successive radiographs are performed and an emerging calcification of the fracture area is evaluated. The aim of this study was to investigate whether different bone healing patterns can be distinguished using a telemetric instrumented femoral internal plate fixator.

Materials and Methods

An electronic telemetric system was developed to assess bone healing mechanically. The system consists of a telemetry module which is applied to an internal locking plate fixator, an external reader device, a sensor for measuring externally applied load and a laptop computer with processing software. By correlation between externally applied load and load measured in the implant, the elasticity of the osteosynthesis is calculated. The elasticity decreases with ongoing consolidation of a fracture or nonunion and is an appropriate parameter for the course of bone healing. At our centre, clinical application has been performed in 56 patients suffering nonunion or fracture of the femur.

Results

A total of 39 cases of clinical application were reviewed for this study. In total, four different types of healing curves were observed: fast healing; slow healing; plateau followed by healing; and non-healing.

Conclusion

The electronically instrumented internal fixator proved to be valuable for the assessment of bone healing in difficult healing situations. Cost-effective manufacturing is possible because the used electronic components are derived from large-scale production. The incorporation of microelectronics into orthopaedic implants will be an important innovation in future clinical care.

Cite this article: B. Kienast, B. Kowald, K. Seide, M. Aljudaibi, M. Faschingbauer, C. Juergens, J. Gille. An electronically instrumented internal fixator for the assessment of bone healing. Bone Joint Res 2016;5:191–197. DOI: 10.1302/2046-3758.55.2000611.

Patients' Adherence in the Maintenance Therapy of Children and Adolescents with Acute Lymphoblastic Leukemia

BACKGROUND

Acute lymphoblastic leukemia (ALL) is the most common form of paediatric cancer. Maintenance therapy as last treatment phase includes oral chemotherapy with methotrexate (MTX) and mercaptopurine (6-MP), self- or parent-administered at home, given for about 1 ½ years, and qualified as decisive for an optimum therapy outcome. The aim of our study was to analyze factors influencing the adherence of patients with ALL undergoing maintenance therapy and their families.

METHODS

A multi-method study was undertaken between 11/2011 and 10/2014 with patients surveyed by the Hannover Medical School outpatient clinic, including a questionnaire survey and qualitative interviews with parents as well as blood samples of the patients.

RESULTS

33 questionnaires, 27 interviews and blood samples of 26 patients could be analyzed. Only one third of the blood samples showed concentrations of the 6-MP active metabolite within the therapeutic reference range. Parents named the clinical doctor as their main advisor on medication intake. 36% (12/33) of the participants stated that medication intake has not always occurred the way medication was prescribed. Drug formulation and drug intake information could be identified as determinants of adherence. Parents' problems to obtain information are partly caused by different study results concerning the correct timing of the drug intake and drug interactions with milk products.

CONCLUSION

Parents' information on drug therapy should be more consistent and the pharmaceutical formulations have to be adapted to patients' needs to improve adherence and thereby the chance of long-term remission.