Christopher Fuller

• University College London

Introduction: The number of national hand-hygiene campaigns has increased recently, following the World Health Organisation's (WHO) "Save Lives: clean your hands" initiative (2009), which offers hospitals a multi-component hand-hygiene intervention. The number of campaigns to be evaluated remains small. Most evaluations focus on consumption of alc...

Background Sepsis has a mortality rate of 40 %, which can be halved if the evidence-based “Sepsis Six” care bundle is implemented within 1 h. UK audit shows low implementation rates. Interventions to improve this have had minimal effects. Quality improvement programmes could be further developed by using theoretical frameworks (Theoretical Domains...

Executive Summary Susan Hopkins, Alan Johnson Chapter 1 Susan Hopkins, Berit Muller-Pebody, Alan Johnson Chapter 2 Rebecca Guy, Sarah Gerver, Dean Ironmonger, Richard Puleston, Alan Johnson TB: Miranda G. Loutet, Maeve K. Lalor, Jennifer A. Davidson, Tehreem Mohiyuddin and H. Lucy Thomas. Gonorrhoea: Hikaru Bolt, Antara Kundu, Katy Town, Martina Fu...

Background: In December, 2010, National Health Service (NHS) England introduced national mandatory screening of all admissions for meticillin-resistant Staphylococcus aureus (MRSA). We aimed to assess the effectiveness and cost-effectiveness of this policy, from a regional or national health-care decision makers' perspective, compared with alterna...

Background: Sepsis is a major cause of death from infection, with a mortality rate of 36 %. This can be halved by implementing the 'Sepsis Six' evidence-based care bundle within 1 h of presentation. A UK audit has shown that median implementation rates are 27-47 % and interventions to improve this have demonstrated minimal effects. In order to dev...

Background The Feedback Intervention Trial was a national trial of an intervention to increase hand hygiene behavior in English and Welsh hospitals. It significantly improved behavior, the effect increasing with fidelity to intervention, but the intervention proved more difficult to implement than anticipated. This study aimed to identify the barri...

Insufficient use of behavioral theory to understand health care workers' (HCWs) hand hygiene compliance may result in suboptimal design of hand hygiene interventions and limit effectiveness. Previous studies examined HCWs' intended, rather than directly observed, compliance and/or focused on just 1 behavioral model. This study examined HCWs' explan...

The English Department of Health introduced universal MRSA screening of admissions to English hospitals in 2010. It commissioned a national audit to review implementation, impact on patient management, admission prevalence and extra yield of MRSA identified compared to "high-risk" specialty or "checklist-activated" screening (CLAS) of patients with...

Achieving a sustained improvement in hand-hygiene compliance is the WHO's first global patient safety challenge. There is no RCT evidence showing how to do this. Systematic reviews suggest feedback is most effective and call for long term well designed RCTs, applying behavioural theory to intervention design to optimise effectiveness.Three year ste...

Model formula and general statistical approach to stepped wedge trials. (DOC)

CONSORT checklist for FIT. (DOC)

Feedback Intervention Trial Protocol. (DOC)

To evaluate the impact of the Cleanyourhands campaign on rates of hospital procurement of alcohol hand rub and soap, report trends in selected healthcare associated infections, and investigate the association between infections and procurement. Prospective, ecological, interrupted time series study from 1 July 2004 to 30 June 2008. 187 acute trusts...

Web appendix: Supplementary information

IntroductionAchieving a sustained improvement in hand-hygiene compliance is the WHOs first global patient safety challenge. There is no RCT evidence showing how to do this. Systematic reviews suggest feedback is most effective and call for long term well designed RCTs, applying behavioural theory to intervention design to optimise effectiveness. Me...

Wearing of gloves reduces transmission of organisms by healthcare workers' hands but is not a substitute for hand hygiene. Results of previous studies have varied as to whether hand hygiene is worse when gloves are worn. Most studies have been small and used nonstandardized assessments of glove use and hand hygiene. We sought to observe whether glo...

Ward procurement of hand hygiene consumables is a proxy measure of hand hygiene compliance. The proportion of this due to use of alcohol hand rub (AHR) at ward entrances, and bedside use of consumables by patients and visitors, is unknown. Thirty-six hours of direct observation of bedside hand hygiene behaviours by healthcare workers (HCWs), patien...

Background: The volumes of alcohol hand rub &soap procured by wards provide a proxy measure of hand hygiene compliance. This may be distorted by use of AHR at ward entrances & bedside use of AHR/soap by patients’ & visitors. In England & Wales, the national cleanyourhands campaign promoted use of bedside AHR by HCWs. An unintended consequence of...

Background: WHO guidelines stipulate that gloves are required for specific clinical procedures but warn that they are not a substitute for disinfecting or cleaning hands. It has been suggested previously that wearing gloves could be a barrier to good hand hygiene compliance but the literature is divided as to whether healthcare workers (HCWs) are l...

Trials evaluating interventions to improve health care workers' hand hygiene compliance use directly observed compliance as a primary outcome measure. Observers should be blinded to the intervention and the effectiveness of blinding assessed to prevent systematic bias. The literature has not addressed this issue, and this study describes a robust a...

Previous observational measures of healthcare worker (HCW) hand-hygiene behaviour (HHB) fail to provide adequate standard operating procedures (SOPs), accounts of inter-rater agreement testing or evidence of sensitivity to change. This study reports the development of an observational tool in a way that addresses these deficiencies. Observational c...

Objective: In order to develop and evaluate effective interventions to improve hand hygiene behaviours amongst hospital staff and reduce hospital acquired infections, a valid and reliable measure of hand hygiene behaviour is needed. This study develops an observational measure for use in a cluster randomised controlled trial of the effectiveness of...